Ex-Smokers' Kids More Likely to Light Up

Action Points

Note that this longitudinal family study demonstrated that children of current or past smokers were significantly more likely to take up smoking than children of non-smokers.

Older sibling smoking appears to be a mediator of this effect -- suggesting a target for interventional trials.

Smokers were more likely to have a 'tween or teen who followed in their footsteps, even if they quit before the child was born, a multigenerational study showed.

The rate of smoking reported by kids ages 11 and older was 23% to 29% among those whose parents had once smoked or currently smoked compared with 8% among children of never smokers, Mike Vuolo, PhD, of Purdue University in West Lafayette, Ind., and Jeremy Staff, PhD, of Pennsylvania State University in University Park, found.

The children of teen smokers who later quit or cut back substantially were still 3.2-times more likely to smoke than those whose parents never took up the habit, the researchers reported in the September issue of Pediatrics.

"Intervention efforts to heighten parental disapproval of smoking and weaken possible intergenerational influences should target parents who were smokers at any point from adolescence to adulthood," they recommended.

Clinicians should ask parents about former smoking and keep that family history in mind as they would a family history of heart disease, suggested John Spangler, MD, a family and community medicine specialist at Wake Forest Baptist Medical Center in Winston-Salem, N.C.

Other possible explanations are that parents model and reinforce the behavior in their children, or that the link is indirect through associations with weaker attachment to parents, psychological distress, or other factors, the researchers noted.

Still, parents shouldn't feel that there's nothing they can do to help their children avoid the same path, Spangler noted.

"A parent should take the opportunity to make it a teachable moment," he suggested. "There's nothing you can do about your past history of smoking; there is something you can do about your current history of smoking. But if you talk and engage the child in a healthy lifestyle, it may make you more likely to quit and also make the child less likely to start smoking."

The study included two generations in the Youth Development Study: A random sample of ninth grade students in St. Paul, Minn., followed from 1988 through to age 38 and then the children of that cohort starting at age 11 (mean 15, range up to 21).

In the original cohort, 54% remained stable nonsmokers from their teens through their 30s. The rest followed a few different trajectories:

16% started light smoking in their teens but then quit or cut back substantially by the latest follow-up in adulthood

16% smoked in high school, typically at least half a pack a day, and largely continued through to age 38

14% started smoking after high school, with 67% still doing so by the latest follow-up in adulthood

Overall, 16% of the second-generation children reported smoking in the prior year.

The odds were 3.2-fold higher for children of early-onset light smokers, 3.8-fold elevated among children of early-onset heavy smokers, and 4.6 for the late-onset smokers.

Adjustment for parent and child factors didn't eliminate the statistical significance of these associations.

But adding in smoking reported from older siblings in the family, which conferred a 6.3-fold elevated likelihood of smoking in the younger siblings, eliminated the impact of early-onset, persistent heavy smoking by a parent, suggesting a mediating effect in that comparison.

Limitations of the study included the relatively low level of education of the original cohort, that smoking information came from only one parent rather than both, and an inability to determine direction of association or causality.

The study was supported by a grant from the National Institute of Child Health and Human Development and previously by the National Institute of Mental Health.

The researchers reported no conflicts of interest.

Reviewed by F. Perry Wilson, MD, MSCE Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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